Medical Power Flashcards
French and Raven (1959)’s 5 bases of power within organisations
- Legitimate (formal authority within org.)
- Referent (ability to persuade/influence)
- Expert (possessing needed skills/experience)
- Reward (ability to give benefits)
- Coercive (punish/withhold reward)
Definitions of medical power
- Ability to impose one’s will on others even if they resist in some way
- Real or perceived ability or potential to bring about significant change in people’s lives through one’s actions
- Power to define illness and accordingly manage those who are ill
How power operates
- Through professions and their organisations
- Institutions of knowledge
- Institutions of practice
- Personal interaction with patients
- In wider society
Characteristics of professions
- Body of knowledge (theory + skills)
- Regulated training overseen by profession
- Monopoly of practice through registration
- Autonomy (self-regulating, make own rules)
- Interaction with government
- Interprofessional care/teamwork
Social role of profession within the profession
- Self-interest (staying autonomous, dominance over other professions)
- Upholding ethical values
- Sense of belonging
Social role of profession outside the profession
- Embodying wider role of service
- Social status
Freidson (1988) medical dominance definition
Authority that the medical profession can exercise over:
- Patients
- Other occupations within healthcare
- Society
Advantages of a diagnosis/label
- Expectation of treatment
- Offers socially acceptable explanation (eg. for behaviour)
- Sympathy
- Aids coping with illness
- Sick pay
- Access to prescriptions
- Insurance payments
Disadvantages of a diagnosis/label
- Major change in status from ‘person’ to ‘patient’
- Must accept asymmetry of relationship with doctor
- May not be able to get (cheaper) insurance, mortgage, employment
Parsons (1951)’s obligations of the ‘sick role’ for the patient
- Must want to get well as quickly as possible
- Should seek professional advice/co-operate with doctor
- Are allowed/expected to shed normal activities + responsibilities
- Should be regarded as being in need of care and unable to get better by own decisions/will
Parsons (1951)’s expectations from the doctor
They should:
- Apply high degree of knowledge/skill
- Act for welfare of patient + community rather than own self-interest
- Be objective (not judge patient, not become emotionally attached, etc.)
- Be guided by rules of professional practice
What is socialisation?
Mechanisms by which people learnt the rules, regulations and acceptable ways of behaving in society or group they belong to
Types of socialisation
- Primary
- Secondary
- Anticipatory
Where does each type of socialisation take place?
- P = in the family (eg. gender role - blue for boys)
- S = throughout life (school, peer group, etc.)
- A - when rehearsing for future position (applying to med school, etc.)
What is patient socialisation?
Learning ‘correct’ behaviour as a patient and how to interact with healthcare systems
Examples of where patient socialisation can occur from
- Own experience in the system
- Family/friends
- Other patients
- Material published by organisations/charities
- Hospital leaflets of ‘what to expect’
Inverse care law (Tudor Hart 1971)
Those who most need medical care are least likely to receive it
Characteristics of total institutions (Goffman, Asylums)
- All aspects of life are conducted in the same place under a single authority
- Daily life is carried out in groups (“batch living”) with scheduled activities
- Sharp distinctions between managers and managed, between whom there is little communication
- There is an institutional perspective, therefore assumption of an overall rational plan
Mechanisms used in institutions to facilitate management of inmates
- Physical/psychological reminders of a person’s identity being stripped (removing personal possessions, restricting privacy)
- Information about individual and institution is controlled
- Mobility restricted
What is institutionalisation?
Patient becomes unable to undertake simple tasks on their own or make decisions
Goffman’s 5 modes of adaptation an inmate can employ at different stages in their career in the institution
- ‘Situational withdrawal’ (no contact with others)
- ‘Intransigent line’ (patient refuses co-operation)
- ‘Colonisation’ (hospital preferable to alternative)
- ‘Conversion’ (becoming model patient)
- ‘Playing it cool’ (variety of strategies including the above depending on situation)
Evidence of permeability in an institution
- Ward membership is temporary or ‘revolving’
- Contact with outside world is maintained
- Institutional identities are blurred
Consequences of permeability in an institution
- Reduced risk of institutionalisation
- Potentially increased risk to staff + patients
Management of permeability in an institution
- Limiting unwanted movement
- Using discretion
- Patient input (negotiation + subversion)
Threats to medical power
- Shifting intra-professional division of labour; team based approaches
- CAM
- Technological developments
- Availability/accessibility of information
- Patient empowerment
- Erosion of autonomy
